New Symptoms ... Hoping for some guidance

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Susan117
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October 31, 2014 at 11:32 pm

Post count: 18

#11638

Dr. Corenman,
The past 2-3 days, I have had some new symptoms that have caused me to worry. I plan to call the doctor but just not sure if I should call the physiatrist I have been seeing or my family doctor….or go the ER??

My leg weakness has progressed to include ankle and foot pain, stiff contractions in my ankle that I cannot control (doesn’t feel like a muscle spasm)…it turns outward involuntarily. This has been happening while I am just sitting for the past couple of nights and while laying in the bed. Last night, it started again while we were in the car but it started with numbness and tingling in my pinkie toe and the toe next to it. I thought my shoes were too tight so I loosened them but it didn’t help. Almost immediately after that started, my ankle, outside of my hip and the front of my shin began contracting and tightening and I had 10 out of 10 pain in the top of my foot (all of this on the right side). It would subside and then begin again within a couple of minutes.It did this beginning at about 6:30pm and lasted about 3-4 hours on and off. When it stopped, I still felt really weak in my right side from my hip to my feet. Do you think this is an emergency or can it wait to see the doctor? Any idea what is causing it? I had lumbar back pain with this as well but the leg and foot pain was way worse. Thanks for any guidance you can give me.

Susan117
Member

November 6, 2014 at 9:37 pm

Post count: 18

#11680

Went to the dr and he believes my foot pain, toe burning and the feeling of shin splints are all a symptom of a possible L4 herniation with nerve impingement. He has ordered an MRI. If it turns out to be this, will it require surgery? He also out me on a 5 day dose of oral steroids, rest.

Donald Corenman, MD, DC
Moderator

November 7, 2014 at 8:02 pm

Post count: 8660

#11688

Symptoms could be from a disc herniation at L4-5. You do need an MRI to determine the source of pain. Surgery is indicated if you have motor weakness. A good examination will reveal this. WIthout motor weakness, you could improve from epidural steroid injections and PT but it depends upon how severe your pain is. See the section “when to have lower back surgery” to understand your options.

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.

Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.

Susan117
Member

November 7, 2014 at 8:15 pm

Post count: 18

#11690

Thank you for your answer. I have an MEI scheduled for Tuesday with results appt on the 17th. Weakness is getting worse….I have missed two days of work already :( I will let the forum know what the MRI says as soon as I know!

Susan117
Member

December 5, 2014 at 2:00 am

Post count: 18

#11821

Update: Had the MRI and 10 minutes into it, the technician pulled me out and said there was too much artifact. The dr sent me for a CT the next day…..same thing. Next step was an EMG/NCS which came back normal but during the test, when the needle was stuck into my right outside hip area I could not feel a thing….not even the electrical part. Afterwards, he tested my strength and determined that there was still significant weakness. He has now ordered a CT myelogram hoping it will show something. I am most concerned that all of this is due to my L5/S1 TLIF surgery in November 2013. I have had a funny feeling with movement, walking since surgery and still do…now along with a strange pinching feeling in that area with normal walking and even when I’m sitting or lying down…it shoots really sharp sometimes. I wonder if the CT Myelogram will show if I have a failed fusion or other problems in the fusion area? If not, what tests will show what is going on (given the fact that standard tests…MRI, CT….do not work for me due to all the hardware I have!). Thank you!

Donald Corenman, MD, DC
Moderator

December 8, 2014 at 8:58 pm

Post count: 8660

#11828

Artifact with MRI or with CT scan that makes the films unreadable is very unusual. You must have hardware implanted in your spine to make these films unreadable. Did you have previous spine surgery with stainless steel implants? Titanium implants are MRI and CT friendly.

Ordering a new CT myelogram if the CT scan was unreadable is not going to be effective. The same blurring effect will be noted.

There are significant differences in different departments and skills of radiological techs (along with radiologists who can order different types of scans) to make imaging readable. You should not have problems with an MRI or with a CT as I order these tests all the time in patients who have had previous surgery without difficulty in reading these tests.

That is unless you have had stainless steel implants which I don’t believe are sold anymore. If you did have these implants, these might need to be removed to get a good MRI image. A CT image still should be obtainable as I see patients with old scoliosis surgeries using stainless implants and still get good images.

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.

Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.
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Donald Corenman, MD, DC

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81 reviews

Eric S

Sep 26, 2021

by Eric S on Donald Corenman, MD, DC

Successful pars repair at 46 years old

Back in November of 2018 (at 46 years old) I came from Vancouver BC to have a pars repair done with Dr. Donald Corenman at the Steadman Clinic in Vail Colorado. I'm finally posting this review nearly three years later in late 2021. The reason I waited so long was I wanted to know the final result before I posted my review. Unfortunately in that time Dr. Corenman has retired. Nevertheless, I want to post this review of Dr. Corenman and his staff at the Steadman Clinic in their excellent treatment of my L5 pars interarticularis.

I fractured my pars at age 42 back in 2014 when rolling on the gym floor, and was denied treatment by the Canadian healthcare system, probably due to my age. First my GP told me there was no surgical option for a pars defect, which was quite incorrect! I tried to live with it, but the symptoms worsened (periodic random spine slippage and weeks of resultant pain after just bending over to tie my shoe, so I eventually learned to mostly squat and hardly bend). When I finally consulted with Canadian spine surgeons, I was told they believed my pars defect had been congenital (since birth). This was absurd, considering I had done extreme martial arts (including jiu jitsu) for years prior, as well as 5 years of reinforcing steel full time in my 20s, probably the hardest job on the back you can find. No pars defect like mine would possibly have allowed this--ergo it was impossible that I had had the defect since birth. I did however have an asymptomatic congenital spina bifida occulta that made me more susceptible to a pars fracture. In 2014 in one instant, I went from having the strongest back people I knew said they'd ever seen, to being unable to safely bend over and tie my shoe without a non-negligible risk of my spine slipping randomly (which would lead to weeks of pain after each occurrence). This was due to the unilateral L5 pars defect, otherwise known as spondylolysis. It was when lying in pain on the floor 4 years later after maybe the 6th spine slippage event post injury, that I had had enough, and resolved to have surgery. If Canada's "universal health care" said no, I would make lemonade from lemons, and find the very best surgeon in the world at pars repairs. That was Dr. Donald Corenman. Dr. Corenman back in 2018 ran a website https://neckandback.com/ that dedicated many pages to the science of every aspect of pars repairs, from eligibility (good discs on MRI), to best surgical techniques (minimal open compared to minimally invasive), best imaging to use (i.e., O-Arm with Stealth imaging vs. older fluoroscopy), the ideal amount of BMP to use and why not use too much or too little, and much more, all to do with pars repairs, pages upon pages of his site just on the pars, with scientific references and his own extensive expert opinion. As a health research statistician, I was very impressed with this. It was in stark contrast to the websites of other spine surgeons which barely gave the pars a word or two, focusing almost exclusively on fusions. I had found the best surgeon in the world for pars repairs, and so after Dr. Corenman personally screened my MRI to ensure my discs were healthy, I booked the surgery.

Being 46 years old at the time of surgery in 2018, with a 4-year-old pars fracture from 2014 combined with a congenital SBO meant my pars fragment was somewhat atrophied, but it was "very solid", said Dr. Corenman in the operative report. Nevertheless, it was challenging with two things to fix, the pars and SBO, and OR time was around 4 hours. Recovery over the following months was guided by a very clear "Spine binder" from the Steadman Clinic with strict rules of "no BLT" (no bending, lifting or twisting), and illustrated physiotherapy guidelines. They even warned patients to avoid fish oil supplements, which could excessively dampen inflammation and hence slow bone healing. They answered many questions I had during months of recovery, with responses coming from the very supportive Lori Fugate (then director of Dr. Corenman's practice), and Ehrich Bean (then physician's assistant at the practice), as well as a couple calls with Dr. Corenman himself after two of the CT scans. Ehrich Bean offered great advice for taking the spine binder conservatively due to the nature of pars repairs vs. fusions. The final post-op CT scan I had was a couple weeks ago at 34 months post-op, and Dr. Corenman had retired, but I got a very positive and informative call from Eric Strauch (current PA at the Steadman Clinic under Dr. Corenman's replacement there, and who had also worked with Dr. Corenman previously). The staff at the Steadman Clinic were extremely supportive all the way through the process. I should mention, the local Canadian spine surgeon did offer me very good post-operative support including antibiotics as needed to deal with a mild surface incision-site infection early on, booking numerous x-rays when I felt something was amiss, as well as booking all four of my post-op CT scans. I am very grateful for that support also.

My final result shows plenty of solid bone across the pars and a healed SBO, with my vertebral body now a solid bone ring instead of being broken at two places as it was pre-op. Does my spine hold up in the real world? You bet! I have recently dug and moved several yards of dirt and sand and gravel by myself (shovel and wheelbarrow!) to fix our water main, pulled roots from the yard, moved several "portable" (these are HUGE) air conditioners up several flights of stairs my myself, and lifted weights. I now run 2 miles (3.2 KM) several times weekly with a hard 100 meter dash in the middle. I bend deeply before each run I go on, with no spine slippage. My spine feels amazing. I can bend over to do exercise, or real word tasks, with no risk of spine slippage.

My sincere thanks to God, Dr. Donald Corenman, Lori Fugate, Ehrich Bean, Eric Strauch, and the Steadman Clinic, as well as the Canadian spine surgeon who offered me excellent post-operative care back in Canada. You have all given me a new lease on life.

Sincerely,
Eric S

Robert S

May 11, 2021

by Robert S on Donald Corenman, MD, DC

Back Fusion Surgery

I had my entire lumbar spine fused in November of 2018. I had scoliosis , with pinched nerves that were so painful I could hardly walk - and standing for more than a few minutes was impossible. Even sitting was painful.
The fusion surgery produced immediate relief! And the recovery was much easier than I expected.
To this day I can do all the activities I love from hiking, to standing in a stream fly fishing to riding my bike long distances - or just walking down the street with my wife.
Kudos to Dr. Corenman and his staff, (including the two Erics) for taking such good care of me!

Leslie R

Jul 9, 2020

by Leslie R on Donald Corenman, MD, DC

TLIF

I had my TLIF surgery on 6/24/2020 by Dr. Corenman, I can not say enough good things about the Dr or his staff. I was always treated with respect and explained everything throughly, that made it easy for everyone to understand. I highly recommend Dr. Corenman and the Steadman Clinic.

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New Symptoms … Hoping for some guidance